Introduction:

Pregnancy in Systemic Lupus Erythematosus (SLE) patients is associated with a high rate of fetal loss and pregnancy complications which are about 24 times higher than non-SLE patients. The rates are felt to be even higher in African-American (AA) patients, but an exact prevalence and risk is not yet characterized. We undertook this study to assess the risk of fetal loss and complications in SLE patients at University of Mississippi Medical Center, caring for predominantly (gt]90%) AA patients.

Discussion:

We found SLE significantly increased the risk of fetal loss in 2nd and 3rd trimesters (OR 6.49). The risk was similarly increased in this study for miscarriage (fetal loss<20 weeks) and stillbirth (fetal loss>20 weeks). In contrast, patients who were being treated with hydroxychloroquine (OR 2.28) or were compliant (OR 1.6) only had a minor increase in the risk as compared to control group. SLE patients had increased likelihood of having baseline hypertension, pre-eclampsia and pre-term labor. There was no increase in likelihood of association with hyperglycemia, C-sections, HELLP syndrome, anti-phospholipid antibodies or lupus activity markers in our comparison.

Our data suggest the likelihood of the fetal loss (6 vs 4 times), any complication (80% vs 50%), pre-eclampsia(33% vs 20%) or pre-term labor (50% vs 33%) may be higher than previously reported. The AA ethnicity may be a contributing factor here but a small sample size limits further characterization of the specific factors contributing to the increased risk.

Conclusion:

There is a marked increase in risk of fetal loss and adverse pregnancy complications in African-American SLE patients many of which are higher than previously reported. Plaquenil and compliance with physician care seem to help decrease the likelihood of these adverse outcomes.